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 THE EFFECTS OF EMANCIPATION UPON THE 
 MENTAL AND PHYSICAL HEALTH OF THE NEGRO 
 OF THE SOUTH 
 
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THE EFFECTS OF EMANCIPATION UPON THE 
 
 MENTAL AND PHYSICAL HEALTH OF THE 
 
 NEGRO OF THE SOUTH- 
 
 By. J. F. "Miller, M-'D., Superintendent Eastern 
 Hospital, Goldsboro, N. C. 
 
 [Reprinted from the North Carolina Medical Journal.] 
 
 THE EFFECTS OF EMANCIPATION UPON THE MENTAL AND 
 PHYSICAL HEALTHOF THE NEGRO OF THE SOUTH* 
 
 By J. F. Miller, M.D., Superintendent Eastern Hospital, Goldsboro, N. C. 
 
 From the Afro-American Encyclopedia, I gather the following statistics: 
 "African population of the United States, - - - 7,470,040. 
 Of this number, there are pure Africans, - - - 6,337,980. 
 
 Of mulattoes (one-half pure) 956,989. 
 
 Of quadroons (one-fourth pure) 105,135. 
 
 Of octaroons (one-eighth pure) 69,936." 
 
 In round numbers, six millions live in the South. 
 
 I observe that the States of Louisiana, Mississippi and South Carolina have 
 more negroes than whites. 
 
 The literature of insanity and physical degeneration among this popula- 
 tion thus far is comparatively meagre ; and it will devolve upon us of the 
 South who are in the midst of these people', to write it. 
 
 This writer has been thoroughly reconstructed and readjusted to the 
 changed political relations of the negro. He has no controversy with man, 
 nor complaint against the great Disposer of human events for the results of 
 the late war between the States. Nor has he any prejudice against the man- 
 umitted slave or his posterity. In common with the great mass of Southern 
 people, he is the negroe's friend. 
 
 *Read before the Southern Medico-Psychological Association, at Asheville, N. C, Septem- 
 ber 16, 1896. 
 
2 Miller — TV/.? Effects of Emancipation Upon the Menial and Physical, etc. 
 
 That inimitable American wit and humorist, Mark"Twain, says that Adam 
 is a very much neglected man; that he deserves a monument and that he 
 would subscribe liberally for the purpose; that the world is indebted to him 
 more than to any other man, for he gave us both hell and heaven. 
 
 The faithful negroes of the South deserve a monument also for their loy- 
 alty to their owners and fidelity to duty under the most trying circumstances 
 during the years of the late civil war. 
 
 But relegating to the domain of politics and sociology, the many vexed 
 questions embraced in the so-called negro problem, the alienist and the stu- 
 dent of scientific medicine may well inquire: What has been the effect of 
 freedom upon the mental and physical health of the negroes of the South? 
 
 Has it been damaging or otherwise? 
 
 It is the purpose of this paper briefly to answer this question. To do so, 
 I must needs state some facts and figures heretofore given by others who 
 have written on this subject. 
 
 THE HEALTH OF THE NEGRO PRIOR TO EMANCIPATION. 
 
 From close personal observation, embracing a professional life of nearly 
 forty years among the negroes and from data obtained from professional 
 brethren in different sections of the South, I have no hesitancy in declaring 
 that insanity and tuberculosis were rare diseases among the negroes of the 
 South prior to emancipation. 
 
 Indeed, many intelligent people of observation and full acquaintance of 
 the negro have stated to me that they never saw a crazy or consumptive negro 
 of unmixed blood until these latter years. 
 
 The fact of their comparative exemption from these ailments prior to 
 emancipation is so well established that I deem it unnecessary to lengthen 
 this paper by additional testimony that could be readily furnished from phy- 
 sicians of large practice among the negroes prior to emancipation. 
 
 INSANITY AND TUBERCULOSIS SINCE KM ANCIP ATION. 
 
 It is now -proper to inquire what is and has been the history of the negro 
 as to these ailments since emancipation. 
 
 Abundant testimony from practicing physicians throughout the South, is 
 not wanting to establish the fact that negroes no longer enjoy immunity from 
 these ailments. 
 
 Let us look at the testimony of our hospitals for the insane. Until the 
 opening of the Eastern North Carolina hospital for the accommodation of 
 the colored insane of the State, August i, 1SS0, the State of North Carolina 
 had but one hospital for the care and treatment of all her insane population. 
 
 Accommodations being thus limited, it is fair to assume that many of the 
 colored insane were confined in jails and county homes or cared for by their 
 friends. Therefore the number ot patients received from the Raleigh asylum 
 
Miller — The Effects of Emancipation Upon the Mental and Physical, etc. 3 
 
 into the Eastern hospital at its opening does not fairly represent the number 
 of insane among the colored population of the State at that time. But dur- 
 ing the year, there were admitted into the Eastern hospital from the Raleigh 
 asylum and from the State at large one hundred insane negroes. 
 
 This embraces the accumulation of the first decade and a half after the 
 close of the civil war. At this writing, another decade and ■; half later, there 
 are under treatment in the Eastern hospital three hundred and seventy-five 
 negroes, and I have reason to believe that .here are quite as many outside as 
 there were in 1880. 
 
 In a paper read by Dr. T. O. Powell, Superintendent of the Georgia Lun- 
 atic asylum, before a meeting of this association held at Atlanta, I gather 
 the following facts: 
 
 "The census of i860 will show that there were only forty-four insane 
 negroes in the State of Georgia, or one insane negro in every 10,584 of pop- 
 ulation, and consumption in the full blooded negro was rarely seen. 
 
 The census of 1870 shows that there were 129 insane negroes in the State 
 of Georgia, or one in every 4,225. 
 
 The census of 1880 gives 411 colored insane or one to every 1,764 of pop- 
 ulation. 
 
 The census of 1890 gives 910 colored insane or one to every 943 of popu- 
 lation." 
 
 According to the figures of the United States Census Bureau^ the number 
 of colored insane of the United States were, in 1S50, 638, giving a ratio of 
 175 per million inhabitants; in i860, 766, giving a ratio of 169 per million 
 inhabitants; in 1870, 1,822, giving a ratio of 367 per million inhabitants; in 
 1880, 6, 157, giving a ratio of 91 2 per million inhabitants ; in 1890, 6, 766, giv- 
 ing a ratio of 880 per million inhabitants. 
 
 Commenting upon the above statistics, Dr. J. W. Babcock, Superintendent 
 South Carolina Insane Asylum, says: "We cannot lose sight of the fact that 
 on the basis of the census as compared with insanity in the whites, mental 
 diseases in the negro has arisen from one-fifth as common in 1850 to one-half 
 as common in 1880 and 1890." 
 
 These statistics, I presume, are approximately correct and c&n be substan- 
 tiated by the testimony of the superintendents of the various asylums rep- 
 resented in this association, and I respectfully submit that there is nothing 
 necessary in the way of additional testimony to establish the fact that insan- 
 ity among the negroes of the South has wonderfully increased since the close 
 of the late war. 
 
 I have no reliable statistics at hand as to the extent of tuberculosis among 
 the negroes since the war, outside of insane asylums ; but the testimony of 
 hospitals that tuberculosis among the negroes has increased pari passu with 
 insanity. Indeed the one is often the accompaniment of the other, if not its 
 legitimate sequence. 
 
4 Miller — The Effects of Emancipation Upon the Mental and Physical, etc. 
 
 Statistics of all our Southern hospitals for the insane furnish abundant 
 testimony that consumption in its various forms is a scourge of the colored 
 insane as well as of the white. 
 
 The statistics of the Eastern North Carolina Hospital for Colored Insane, 
 on this subject are as follows : The average mortality from tuberculosis since 
 the opening in August, 1880, to the present time, September 1, 1896, is 25 
 per cent, of the whole number of deaths. 
 
 The per cent, was much less in the early years of its management. While 
 the general mortality has been somewhat reduced, there has been a gradual 
 increase from consumption. Up to 1884, the percentage of deaths in this 
 hospital from tuberculosis was 14 per cent, of the whole, and in 1895, it was 
 27 per cent. 
 
 On this subject, Dr. Powell says: "From observation and investigation, 
 I am forced to believe that insanity and tuberculosis are first cousins or at 
 least closely allied. The sudden outburst of insanity with the colored race 
 of the South came associated with tuberculosis. Hence in obtaining histo- 
 ries of cases as they are brought to our institutions, the hereditary predispo- 
 sition to consumption is carefully inquired into. 
 
 In comparing the death rate in the Georgh asylum between the whites 
 and negroes, although the care and treatment are the same, the proportion 
 of deaths from this disease is larger in the colored race, and I lind the re- 
 sults are the same in other institutions where both races are treated." 
 
 Dr. T. J. Mitchell, Superintendent Mississippi State Lunatic Asylum, says 
 of his hospital that "for the fiscal year 1S92, there were forty-four deaths, 
 fourteen having died of consumption. 
 
 Fiscal year of 1893, twenty-nine deaths, sixteen having died from con- 
 sumption. 
 
 Fiscal year of 1894, there were forty deaths, eighteen having died from 
 consumption. 
 
 Fiscal year of [895, there were thirty-five deaths, eleven having died from 
 consumption. 
 
 Ten months of fiscal year of 1S96, there were forty-eight deaths, twenty- 
 three having died of consumption. 
 
 These figures apply to the colored only, among whom consumption is 
 much more prevalent than among the whites." 
 
 From the above, I find that the death rate in the hospital at Jackson, Miss., 
 for the past five )-ears, from consumption is a fraction over 42 per cent, ol 
 the whole number of deaths. 
 
 The Central hospital at Petersburg, Va.. through the courtesy of Dr. W; 
 F. Drewry, furnishes me with the statistical report of the whole number o ( 
 deaths from all causes, and also the number of deaths from consumption 
 than from any other hospital in which the colored insane are treated. The 
 percentage of this hospital is a fraction over 12. 
 
Miller — The Effects £f Emancipation Upon the Mental and Physical, etc. 5 
 
 There are more congenital defects among the negroes as demonstrated by 
 the large number of symmetrically developed crania. 
 
 I here express the opinion that the mental inferiority of the negro as thus 
 shown in the midst of the environments which have surrounded him since 
 the wai is a leading factor in the development of his insanity. 
 
 The untutored savage can exist and be healthy in mind and body under 
 conditions that will seriously affect the man of finer sensibilities from culture 
 and education. The negro in slavery had "no thought for the morrow, 
 wherewithal he should be fed and clothed," nor did the claims of family 
 press upon him to worry and affect his mind ; no ambitious hopes stirred his 
 brain as to the possibilities of his future; but "far from the madding crowd's 
 ignoble strife," he spent his quiet, humble life in his little log cabin, with his 
 master to care for every want of self and family, in sickness and in health. 
 
 It is an undisputed fact, known to our Southern people that no race of 
 men ever lived under better hygienic restraints or had governing their lives 
 rules and regulations more conducive to physical health and mental repose. 
 Their habits of life were regular, their food and clothing were substantial 
 and sufficient, as a rule, and the edict of the master kept indoors at night 
 and restrained them from promiscuous sexual indulgence and the baneful 
 influences of the liquor saloon. In sickness, he was promptly and properly 
 cared for Ijy physician and nurse. Freedom came to him and a change came 
 over his entire life. 
 
 Having shown that under his former manner of life the negro enjoyed a 
 wonderful immunity from brain and lung trouble, (I confidently assert that 
 the germs of these troubles came to the same man and race in consequence 
 of his changed environments and the manner of his life which followed.} 
 
 In his ignorance of the laws of his being, the functions of citizenship and 
 the responsibilities and duties which freedom imposed, demands were made 
 upon the negro which his intellectual parts were unable to discharge. In 
 his former condition none of these things disturbed his mind. Immediately 
 the restraining influences which had been such conservators of healthfulness 
 of mind and body were removed, thousands left the quiet homes and regu- 
 lar life of the country for crowded and badly ventilated houses of the towns. 
 These were often located in the midst of unhealthy surroundings, their oc- 
 cupants without regular employment ekeing out a precarious existence, ut- 
 terly unmindful of the laws of health. 
 
 It is a matter of surprise that the sudden and wonderful revolution in the 
 social and political condition of the negro should have turned the heads of 
 many and in their roseate dreams of the future, bade them hope for even 
 better things than "forty acies and a mule." 
 
 Man is an organized being and is subject to certain laws which he cannot 
 violate with impunity. These laws affect him in the air he breathes, the food 
 
6 Miller — The Effects of Emancipation Upon the Mental and Physical, etc. 
 
 he eats, the clothes he wears and every circumstance surrounding his habita 
 tion. 
 
 In the wholesale violation of these laws after the war, as previously stated, 
 was laid the foundation of the degeneration of the physical and mental con- 
 stitution of the negro. Licentiousness left its slimy trail of sometimes in- 
 eradicable disease upon his physical being, and neglected bronchitis, pneu- 
 monia and pleurisy lent their helping hand toward lung degeneration. 
 
 It is true there was comparatively little insanity among the negroes during 
 the first decade after the war, but the seeds of disease were being sown which 
 in succeeding years have brought a beautiful harvest of mental and physical 
 degeneration and he is now becoming a martyr to an heredity thus estab- 
 lished. 
 
 During the flush times immediately after the war, while cotton and all 
 farm products and farm labor commanded the highest prices known to this 
 country, the negroes of the South who remained on the farms in their ac- 
 customed pursuits were comfortable and many of them accumulated some 
 property; and during this period there was comparatively little insanity 
 among them. This writer had a large clientele during this period among 
 this class of negroes and he had no better paying patrons according to their 
 ability. But as farm products lowered in price and labor became cheaper 
 and the general hardness of the times increased, their ability to pay dimin- 
 ished and many of them began to suffer not only for the comforts, but for 
 the means of healthful existance. 
 
 I am informed by physicians practicing among the same people that only 
 a few negroes are now able to pay for professional services. 
 
 The mental worry for simple existence has increased with the tightness of 
 the money market, the depreciation of farm products and the price of labor. 
 We all know that worry and trouble coupled with failing physical health are 
 potential factors in causing insanity. I do not believe the negro is an excep- 
 tion to the rule, though he may not be affected by such causes to the same 
 degree as the Caucassian. But he is the mudsill of social life of the South 
 and in times like the present this class of people must necessarily suffer most. 
 I am fully aware that the negro is proverbially improvident and that even 
 now, after thirty years or more of freedom, he takes but little thought for 
 to-morrow, but to-morrow, nevertheless, comes to him and oftimes finds him 
 wholly unprepared to meet its exacting demands for support of self and 
 family. While it may be assumed as a fact that the negro can exist and be 
 comfortable under less favorable circumstances than the white man, having 
 a nervous organization less sensitive to his environments, yet it is true that 
 he has less mental equipoise, and may suffer mental alienation from influ- 
 ences and agencies which would not affect a race mentally stronger. 
 
 From a brochure on Tuberculosis among the Insane, by by Dr. E. D. 
 
Miller — The Effects of Emancipation Upon the Mental and Physical, etc. 7 
 
 Bondurant, assistant superintendent Alabama Insane Hospital, I gather the 
 following : 
 
 "During three years and nine months, beginning October 1, 1S90, 295 
 deaths occurred among the 1,700 patients treated at the Alabama Insane 
 Hospital. 
 
 Of the 179 deaths among white patients, 51, or 28 per cent., were due 
 to tuberculosis; of 116 deaths among negro patients, 49, or 42 percent., were 
 due to tuberculosis. 
 
 In addition to this, a study of our clinical records discovers the fact that 
 in the colored race the disease assumes a much more active and rapidly pro- 
 gressive form, the average duration of fatal cases being markedly shorter in 
 the negro." 
 
 In the report of the South Carolina Hospital for the Insane for the year 
 1895-4, Dr. J. W. Babcock says: "From 1888 to 1893 the deaths from 
 tuberculosis were distributed as indicated by the following table: 
 White — males 38, females 52; total 90. 
 Colored — males 43, females 165; total 208. 
 
 The colored women who died from the disease outnumbered the other three 
 classes by 32. This too when the smallest part of our population consists of 
 colored women. In his report for 1894-5, Dr. Babcock states: During the 
 year the large number of fifty-nine patients died of some form of tubercu- 
 losis. Of these fifteen, two men and thirteen women, were whites; while 
 forty-four were colored, eighteen men and sixteen women." 
 
 Abundant data similar to the above doubtless could be obtained from other 
 hospitals; but the above I respectfully submit is amply sufficient for the pur- 
 poses in view. 
 
 ETIOLOGY. 
 
 Having thus shown by testimony, ample and conclusive, that insanity and 
 tuberculosis were almost unknown diseases of m groes prior to 1865 and 
 having also shown by the same testimony that they are common among the 
 negroes of to-day, the question of greatest interest to the alienist and phy- 
 sician is: What is the relation of freedom to these diseases? 
 
 We sometimes see the last straw that breakes the back of the camel, but 
 fail to discover the many others previously imposed upon the burdened 
 beast. Every asylum superintendent knows how misleading are the causes 
 of insanity as stated in the papers of application. In papers committing 
 negroes to the Eastern Hospital, religion and religious excitement are fre- 
 quently set forth as assignable causes of the insanity of the applicant. While 
 this is sometimes true, it is often untrue. The error is a natural one, owing 
 to the fact that his disease is manifested through his highly emotional, relig^ 
 ious nature. 
 
8 Miller — The Effects of Emancipation Upon the Mental and Physical, etc. 
 
 To arrive at a correct conclusion as to the effects of 'the changed political 
 and social relations on the mental and physical constitution of the negro, it 
 is necessary to know his manner of life during the ante-bellum and post- 
 bellum periods of his history. 
 
 To understand and properly judge any man or race of men, it is necessary 
 to know his heredity, the environments of his life and many other circum- 
 stances that are factors in the formation of his mental, physical and moral 
 constitution. 
 
 A native of Africa and a savage a few generations ago, then a slave for 
 several generations afterwards; this is the man and the race upon whom the 
 high responsibilities of freedom were thrust; a nation literally born in a day. 
 
 The history of the world, so far as I know, furnishes no condition similar 
 to that in which the negroes of the South were placed the first few years 
 after the close of the war. Without education of self or ancestry- and with- 
 out preparation of any sort, the new negro was invested with the highest 
 functions of citizenship before the healing of the marks of the chains that 
 had bound him. 
 
 It is not my purpose or desire to be offensive to our Afro-American citi- 
 zens, or to make them odious by comparison with the Caucasian; but the 
 question of mental capacity is germane to the question under consideration. 
 
 I am fully aware that among the Afro-Americans of the South may be 
 found some orators, eloquent in speech; some who have attained to ripe 
 scholarship, and many others who have demonstrated considerable capacity 
 in the learned professions and in business circles; but as a rule such are of 
 mixed blood. 
 
 Remaining in contact with the superior Caucasian race, with the uplifting 
 influences of its high civilization, it is confidently believed the Afro-Ameri- 
 can will yet reach higher mental developments. But as a class, their mental 
 calibre is small; the convolutions of their brain are few and superficial ; their 
 cranial measurement small and other anatomical facts demonstrate his infe- 
 riority. 
 
 The color of his skin is a mark of inferiority, and not the result of cli- 
 matic influence, as has been declared by some. 
 
 We are informed that four thousand or more years ago, the Caucasian was 
 white, the Mongolian, yellow and the negro, black. The Aryan-Hindoos of 
 pure blood have preserved their fair complexion in a hot and moist climate 
 for some three thousand years, and the color of the Egyptain has not changed 
 for more than forty centuries. We certainly know that for three hundred 
 years the negro of unmixed blood in the temperate climate of the United 
 States is now near the color of his African progenitors. 
 
 It is a anatomical fact that the average weight of the negroe's brain is 
 forty-two ounces, while forty-nine ounces is the recognized average of the 
 Caucasian, 
 
Mitier— The Effects of Emancipation Upon the Mental and Physical, etc. g 
 
 § 
 
 WHY MORE INSANITY AMONG FEMALES THAN AMONG THE MALES. 
 
 In all ages and among all peoples of an inferior race, females suffer most 
 from the worry, labor and privations incident to their pecuniary and social 
 condition. I believe this statement is emphasized and illustrated by the large 
 increase of female patients over males in the Eastern North Carolina Hos- 
 pital. Applications for the admission of females for the past ten years have 
 been about 40 per cent, greater tha^ri those for the males. 
 
 In my report to the Board of Directors for the year 1888, I made the fol- 
 lowing statement : It is an inceresting question in psychological medicine 
 why this disproportion of insanity in sex£s among the colored people. It 
 may be said in general terms that women have a more highly wrought nerv- 
 ous organization than men; their emotions are more easily aroused; their 
 sympathies are more tender; their love is stronger; and while they have more 
 fortitude under physical suffering, their spiritual nature suffers more than 
 man's under a sense of abandonment by those to whom they naturally and 
 of right look for reciprocal affection, protection and support. It is a melan- 
 choly fact that among many of the colored people the sanctity of the marital 
 relation is lightly esteemed and its solemn obligations but indifferently re 
 garded. How often do husbands when the cares of an increasing family be- 
 gin to press with weight upon them, abandon their wives and children under 
 the pretext of going South to work irPturpentine fields, leaving their wives 
 to struggle alone for self and children until excessive labors, an aching heart 
 and utter destitution drive her with a crazed brain within these walls. 
 Cruelty of husbands thus manifested and manifested in many other ways 
 largely accounts for this disproportion. 
 
 In the light of succeeding years, I have no reason to change the opinion 
 then expressed. 
 
 It is not my purpose to enter into the treatment of insanity of the Afro- 
 American. Insanity in the negro and its treatment are practically the same 
 as in the Caucasian. The habits, education and emotions of the negro in 
 his same condition differ as a class from the Caucasian. 
 
 The negro laughs louder, sings louder, prays and preaches louder, than 
 the Caucasian; and is more vulgar in speech and less cleanly in his person. 
 He carries these characteristics into his insane condition and is therefore 
 more noisy, more vulgar and beastly in his habits. 
 
 Mania is the prevailing form of mental derangement and suicides are rare. 
 I have seen but one well defined case of suicidal melancholia in the Eastern 
 North Carolina Hospital for nine years. 
 
 Dr. Berkley, of Baltimore, who has written on Paresis in the Negro, thinks 
 paresis as common to the negio as to the white man, conditions of life being 
 the same. Paresis being a metropolitan disease, this statement is probably 
 
io Miller — The Effects of Emancipation Upon the Mental and Physical 'f-etc. 
 
 correct as to the colored insane of our large cities, but in the rural districts 
 and in our small towns of the South according to my experience, paresis is 
 a rare disease. 
 
 There are some difficulties attending the custodial care and treatment of 
 the colored insane probably not fully appreciated by those whose population 
 is exclusively of the whites. 
 
 The want of previous education in the past of a iarge majority of the col- 
 ored insane restricts us in the means of Diversion. There are but few arti- 
 sans among them and the chief employment must needs be that of the com- 
 mon laborer of the field, while a large number unable to engage in the ordin- 
 ary work of the hospital are left without resources of relief from the tedium 
 and monotony of hospital life. Every asylum officer appreciates the value 
 of moral treatment for the insane, consisting of an intelligent apprehension 
 of their wants, whims and caprices, a kindly sympathy for the afflicted and 
 the thousand and one attentions necessary for the best results. This re- 
 quires intelligence, conscientiousness and tact, not often found in the colored 
 attendant. 
 
 It is a notorious fact that but few colored attendants have the necessary 
 influence over the colored insane that is so desirable in their care and treat- 
 ment. The negro is usually indignant and rebels against the restraints ex- 
 ercised by another negro, and consequently force if often necessary when 
 moral suasion and a stronger personal influence would have accomplished 
 better results in management. 
 
 In the light of the teachings of the last two decades, showing a marvelous 
 increase of insanity among che Afro- Americans, and tyrannized, as I fear 
 they henceforth will be by an heredity from which they cannot escape, I con- 
 fidently believe that in the near future the proportion of insanity among the 
 negroes in the South will be as great, if not greater, than among the whites. 
 
 Their care and treatment is one of the great and pressing duties of humane 
 and Christian statesmanship which the South doubtless will discharge in 
 obedience to the injunction: "Ye that are strong ought to bear the infirmi- 
 ties of the weak." 
 
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